An MRI performed 6 weeks after an ACL rupture in a 25-year-old footballer shows complete ligament discontinuity. In ACL reconstruction, the graft most associated with donor-site morbidity at the patellar tendon but demonstrating the strongest structural properties is:

• A Bone-patellar tendon-bone (BPTB) autograft ✓
• B Hamstring tendon graft (semitendinosus–gracilis 4-strand)
• C Iliotibial band autograft
• D Peroneus longus allograft

Explanation

Bone-patellar tendon-bone (BPTB) autograft using the central third of the patellar tendon with bone plugs is considered the gold standard for ACL reconstruction due to its structural strength (~2977 N ultimate failure load, closest to the native ACL) and reliable bone-to-bone healing in femoral and tibial tunnels. The disadvantage is donor-site morbidity — anterior knee pain, patellar tendinitis, risk of patellar fracture, and kneeling pain. Hamstring graft (4-strand STG) has less donor morbidity but softer fixation (suspensory); it requires longer biologic tunnel healing. The BPTB graft remains preferred for elite athletes requiring high rotational stability.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.